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General NPI Number Information
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NPI Number | 1265466189
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Entity Type | Organization
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Legal Business Name | LITTLE COMPANY OF MARY ANCILLARY SERVICES CORPORATION
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Dates
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Enumeration Date | 07/10/2006
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Last Update Date | 05/09/2025
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Provider Practice Location Address
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Address Line | 5215 TORRANCE BLVD STE 110
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City | TORRANCE
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State | CA
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Zip | 90503-4009
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Country | US
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Telephone | 310-316-2424
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Fax | 310-540-0374
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Provider Business Mailing Address
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Address Line | PO BOX 31001-3017
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City | PASADENA
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State | CA
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Zip | 91110-3017
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Country | US
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Telephone | 310-316-2424
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Fax | 310-540-0374
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Authorized Official
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Title or Position | ASSISTANT SECRETARY ENROLLMENTS
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Name | DONALD W ANDERSON JR.
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Credential |
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Telephone | 425-358-9786
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Scope of Practice (Provider's specialty)
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Taxonomy #1
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Taxonomy Code | 261QR0206X
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Taxonomy Name | Mammography Clinic/Center
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License Number |
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License Number State |
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Taxonomy #2
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Taxonomy Code | 261QR0200X
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Taxonomy Name | Radiology Clinic/Center
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License Number |
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License Number State |
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